PREVALENCE, CHARACTERIZATION AND RISK FACTORS OF CHRONIC CONSTIPATION AMONG SAUDI CHILDREN: A CROSS-SECTIONAL STUDY

Background: Childhood constipation is a common gastrointestinal disorder worldwide and many factors have been associated with the occurrence of constipation. Objectives: The aim of this study was to determine the prevalence and risk factors for chronic constipation among school-age children in Saudi Arabia. Methods: A cross-sectional study was conducted between February 2016 to May 2016 May. We selected the two largest cities: Jeddah and Makah in the Western region of Saudi Arabia. Children aged 7-17 years were recruited from 15 schools, using a random sampling technique in which all students have an equal and independent chance of being selected. A validated self-administered questionnaire on Rome III criteria for diagnosing chronic constipation and its predisposing factors was filled by each participant in a classroom setting. Results: Of the 9100 questionnaires distributed to school children, 7644 (response rate 84%) were completed and analyzed. Chronic constipation was present in 2459 (32.2%) with significant differences in constipation between girls and boys (77.6% vs 22.3%; p <0.001). The significant risk factors for chronic constipation included family history of constipation (OR=2.69, 95% CI = (2.33-3.09) and psychological/behavioral problems (OR=3.02, 95% CI (2.42-3.76). School toilet phobia, night sleeping <7 hours, homework >3 hours/day, omitting breakfast and exercise in school did not predispose the students to develop chronic constipation (all p < 0.001). The following variables were found to be significantly associated with chronic constipation; straining during defecation (OR = 30.15, 95% CI = (24.88-36.53), painful defecation (OR=18.41, 95% CI = (15.89-21.35), bloody stool (OR = 3.97, 95% CI = (3.16-4.99), and fecal incontinence (OR = 7.84, 95% CI = (6.49-9.47). Conclusion: Chronic constipation is a significant health problem among Saudi children. Exposure to stressful life events at school did not predispose the participants to develop constipation. Chronic constipation prevalence of 32.2% in study population warrants preventive measures such as health education and preventing childhood psychological insults.